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Sharma A, Kumar G, Nagpal R, Naranje K, Sengupta A, Jagannath V, Suryawanshi S, Suryawanshi P. Efficacy of an online lung ultrasound module on skill acquisition by clinician: a new paradigm. Front Pediatr 2024; 12:1406630. [PMID: 38919839 PMCID: PMC11197977 DOI: 10.3389/fped.2024.1406630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction Lung ultrasound (LUS) as an assessment tool has seen significant expansion in adult, paediatric, and neonatal populations due to advancements in point-of-care ultrasound over the past two decades. However, with fewer experts and learning platforms available in low- and middle-income countries and the lack of a standardised supervised training programme, LUS is not currently effectively used to the best of its potential in neonatal units. Methodology A cross-sectional survey assessed the efficacy of learning LUS via a mentor-based online teaching module (NEOPOCUS). The questionnaire comprised the clinicians' demographic profile, pre-course skills, and self-assessment of skill acquisition after course completion with ongoing hands-on practice. Results A total of 175 clinicians responded to the survey, with the majority (87.9%) working in level 3 and 4 neonatal intensive care units. Clinicians had variable clinical experience. Of them, 53.2% were consultant paediatricians/neonatologists with over 10 years of experience. After the course, there was a significant increase in clinician confidence levels in diagnosing and assessing all LUS pathology, as evidenced by the increase in median cumulative scores [from baseline 6 (interquartile range, IQR, 6-9) to 20 (IQR 16-24), p < 0.001] with half of them gaining confidence within 3 months of the course. Conclusion An online curriculum-based neonatal lung ultrasound training programme with clinician image demonstration and peer review of images for image optimisation increases self-reported confidence in diagnosing and managing neonatal lung pathology. Web-based online training in neonatal lung ultrasound has merits that can help with the delivery of training globally, and especially in low- and middle-income countries.
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Affiliation(s)
- Alok Sharma
- Department of Neonatal Medicine, Corniche Hospital, Abu Dhabi, United Arab Emirates
| | - Gunjana Kumar
- Department of Neonatology, National Institute of Medical Sciences and Research, Jaipur, India
| | - Rema Nagpal
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, India
| | - Kirti Naranje
- Department of Neonatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Arnab Sengupta
- Department of Pediatrics, University of Toledo College of Medicine, Toledo, OH, United States
| | - Vanitha Jagannath
- Department of Pediatrics, American Mission Hospital, Manama, Bahrain
| | - Sonali Suryawanshi
- Department of Pharmacology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, India
| | - Pradeep Suryawanshi
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, India
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Stoicescu ER, Iacob R, Ilie AC, Iacob ER, Susa SR, Ghenciu LA, Constantinescu A, Cocolea DM, Oancea C, Manolescu DL. Differentiating Viral from Bacterial Pneumonia in Children: The Diagnostic Role of Lung Ultrasound-A Prospective Observational Study. Diagnostics (Basel) 2024; 14:480. [PMID: 38472952 DOI: 10.3390/diagnostics14050480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
This prospective observational study aimed to investigate the utility of lung ultrasound (LUS) in diagnosing and managing pediatric respiratory infections, specifically focusing on viral, bacterial, and SARS-CoV-2 infections. Conducted over a period of 1 year and 8 months, this research involved 85 pediatric patients (showcasing a median age of 14 months) recruited based on specific criteria, including age, confirmed infection through multiplex PCR tests, and willingness to undergo LUS imaging. This study employed a 12-area scoring system for LUS examinations, utilizing the lung ultrasound score (LUSS) to evaluate lung abnormalities. The PCR examination results reveal diverse respiratory pathogens, with SARS-CoV-2, influenza, and bacterial co-infections being prominent among the cases. As an observational study, this study was not registered in the registry. Distinct LUS patterns associated with different pathogens were identified, showcasing the discriminatory potential of LUS in differentiating between viral and bacterial etiologies. Bacterial infections demonstrated more severe lung involvement, evident in significantly higher LUSS values compared with viral cases (p < 0.0001). The specific abnormalities found in bacterial superinfection can be integrated into diagnostic and management protocols for pediatric respiratory infections. Overall, this research contributes valuable insights into optimizing LUS as a diagnostic tool in pediatric pneumonia, facilitating more informed and tailored healthcare decisions.
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Affiliation(s)
- Emil Robert Stoicescu
- Department of Radiology and Medical Imaging, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Research Center for Pharmaco-Toxicological Evaluations, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, Faculty of Mechanics, 'Politehnica' University Timisoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
| | - Roxana Iacob
- Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, Faculty of Mechanics, 'Politehnica' University Timisoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
- Department of Anatomy and Embriology, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania
- Ph.D. School, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Adrian Cosmin Ilie
- Department III Functional Sciences, Division of Public Health and Management, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Emil Radu Iacob
- Department of Pediatric Surgery, 'Victor Babes' University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Septimiu Radu Susa
- Ph.D. School, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Laura Andreea Ghenciu
- Department of Functional Sciences, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Amalia Constantinescu
- Ph.D. School, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Daiana Marina Cocolea
- Ph.D. School, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pulmonology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Diana Luminita Manolescu
- Department of Radiology and Medical Imaging, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
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Su YT, Chen YS, Yeh LR, Chen SW, Tsai YC, Wu CY, Yang YN, Tey SL, Lin CH. Unnecessary radiation exposure during diagnostic radiography in infants in a neonatal intensive care unit: a retrospective cohort study. Eur J Pediatr 2023; 182:343-352. [PMID: 36352243 PMCID: PMC9829594 DOI: 10.1007/s00431-022-04695-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Abstract
UNLABELLED Unnecessary radiation exposure (URE) during radiographic examination is an issue among infants in neonatal intensive care units (NICUs). The causes of URE have not been fully explored. This study investigated the incidence and identified the causes of URE in infants during diagnostic radiography in a NICU. This was a retrospective cohort study. We retrieved and analysed requests and radiographs taken at a tertiary NICU between September and November 2018. URE was defined as the rate of discordance between requests and images taken (DisBRI) and unnecessary radiation exposure in irrelevant regions (UREIR) during radiography. We compared the rates of URE between very low-birth-weight (VLBW, birth weight < 1500 g) infants and non-VLBW infants. A total of 306 radiographs from 88 infants were taken. The means ± standard deviations (SDs) of gestational age and birth weight were 35.7 ± 3.6 weeks and 2471 ± 816 g, respectively. Each infant underwent an average of 3.5 radiographs. The DisBRI rate was 1.3% and was mostly related to poor adherence to requests. The UREIR rates in thoraco-abdominal babygrams were 89.6% for the head, 14.8% for the elbows and 18.4% for the knee and were mainly related to improper positioning of and collimation in infants while performing radiography. The UREIR rates for the head, knee and ankle were higher in VLBW infants than in non-VLBW infants (94.6% vs. 85.6%, 27.0% vs. 11.5% and 5.4% vs. 0.7%, respectively, p < 0.05). CONCLUSIONS URE during diagnostic radiography is common in sick infants and is mainly related to improper positioning and collimation during examinations. Adherence to protocols when performing radiographic examination or using ultrasonography may be a solution to reduce URE in infants in NICUs. WHAT IS KNOWN • The risk of unnecessary radiation exposure (URE) during radiography has been a common and important issue in sick infants in neonatal intensive care units (NICUs). • The new point-of-care ultrasound (POCUS) technique decreases the need for chest films and prevents radiation exposure in neonates. WHAT IS NEW • In the NICU, URE is still a common issue in critically ill infants during radiographic examinations. The causes of URE during diagnostic radiography are mainly due to improper positioning and collimation during examinations. • The incidence of URE in irrelevant regions is higher in very low-birth-weight (VLBW) infants than in non-VLBW infants.
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Affiliation(s)
- Yu-Tsun Su
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Shen Chen
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Lee-Ren Yeh
- Department of Radiology, E-Da Hospital, Kaohsiung, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Wen Chen
- Department of Nursing, E-Da Hospital, Kaohsiung, Taiwan
| | - Yu-Cheng Tsai
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chien-Yi Wu
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yung-Ning Yang
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Leei Tey
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chyi-Her Lin
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan.
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan.
- Department of Pediatrics, National Cheng-Kung University Hospital, Tainan, Taiwan.
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